70 pc healthcare workers are women, yet PPE kits designed keeping men in mind

The COVID-19 imposed pandemic brought several major challenges for frontline healthcare workers. One such problem is the gender inequity around the fit and design of Personal Protective Equipment (PPE), which are broadly made keeping men in mind. 

To initiate a dialogue around this, Women in Global Health launched a research project this year to document and better understand gendered challenges around PPE in the health sector, including an online survey and interviews with women HCWs in over 50 countries.

It is found that women comprise 90 percent of nurses and have been the vast majority of HCWs dealing with patients during the pandemic. Therefore, if medical PPE is not fit for women, it is not fit for the majority of the health workforce. Their findings show that PPE manufacturing standards pay too little attention to the needs of women.

Discomfort during menstruation

Valerie Dkhar, a nurse working in the Nehru Memorial State Dispensary in Shillong, Meghalaya, spoke to HerStory about the challenges faced by her in PPE kits. “We never wore PPE kits before coronavirus time. The last two years of wearing the bulky PPE kits have been the most uncomfortable in my over two and a half decade long career. It is one thing that it’s made of such a material that it makes us sweat a lot and feel icky, but what’s more discomforting is that it doesn’t fit us at all.”

It is very problematic because once we are in the PPE kit, we cannot use the loo every time we need it.

She also shared that PPE kits are the most distressing during menstruation. “We can feel the blood flow while standing and working but can’t go to the washroom again and again to change or to check while wearing the PPE kit. It is very problematic because once we are in the PPE kit, we cannot use the loo every time we need it."

Valerie says that it would be better if PPE kits are made keeping all the shapes, sizes, and frames of people, and if somehow it could be made menstruator-friendly.

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Access and struggles with PPE kits

“Women health workers have always struggled with PPE designed for men. Before COVID only a handful of researchers were looking into it. However, during the pandemic, health workers have had to wear PPEs for long periods, and with thousands of health workers planning to leave their professions, it has become an issue we can no longer ignore. The issue has been spoken about more during COVID-19, for example, in media reports. Yet many women raising concerns to their employers (often male bosses) have been silenced or ignored,” Dr Roopa Dhatt, Executive Director and Co-founder, Women in Global Health, tells us.

Despite increased contact with containment zones and possibly infected individuals, at the start of the pandemic, ASHAs were forced to buy their own PPE kits without government supplies or resources.

On what prompted her to conduct the research and the survey, she says, “In India, Accredited Social Health Activists (ASHAs), a 900,000 strong all-women group of CHWs, have fulfilled a critical role in communities tracing contacts and promoting public health measures. Despite increased contact with containment zones and possibly infected individuals, at the start of the pandemic, ASHAs were forced to buy their own PPE kits without government supplies or resources. Many went on strike because the Indian government failed to respond to their requests for increased pay and adequate PPE supply: some mentioned receiving only one mask in the span of four months. In response to ASHAs’ demands for better PPE and pay, a senior Delhi government official stated that ASHA workers did not require PPE’.”

“This was what prompted Women in Global Health to conduct a survey in 2021 on the access to PPE of women health and care workers in the pandemic,” she adds. 

Findings from the report

One of the main findings from the report as also reflected by Valerie is PPE design does not address diversity among women, their different body and face shapes, and range of headdresses and that women from minorities have felt marginalised. It also found that PPE is not fit for periods, pregnancy, or menopause.

“Some PPE coveralls cannot be removed for women to use the toilet without being discarded. When PPE supply in the pandemic was scarce, women health workers have used adult diapers and limited their liquid intake as coping strategies. Women have experienced discomfort and loss of dignity,” the report stated.

It also raised the issue that inappropriate, ill-fitting PPE has impeded women’s work and caused pain and suffering; wearing PPE on long shifts has resulted in bruises, rashes, and sores.

Dr Roopa believes that women in the health and care sector want decent work, safety, dignity, fair pay, equal leadership and PPE fit for women – so they can do their jobs and deliver the best possible health care for everyone.

“But women are being failed by both PPE and health systems, where gender inequality is entrenched. Women are 70 percent of health and care workers globally, but they hold only 25 percent of decision-making roles. Women are underrepresented in PPE design and manufacture and procurement processes,” she specifies as the main reason why this issue hasn’t been taken up with urgency.